短节段微创通道下Wiltse间隙入路伤椎置钉内固定治疗胸腰椎骨折的疗效分析  

The Comparative Efficacy Analysis of Short-segment Fixation for Thoracolumbar Fractures Using Pedicle Screws at the Fracture Vertebra by Wiltse Gap Approach through Minimally Invasive Canal

作　　者：宋晨阳[1] 刘文革[1] 陈奋勇[1] 李建东[1] 

机构地区：[1]福建医科大学附属协和医院骨科,福州350001

出　　处：《福建医科大学学报》2016年第5期310-314,共5页Journal of Fujian Medical University

摘　　要：目的探讨短节段微创通道下Wiltse间隙入路与传统切开椎弓根钉内固定治疗不伴神经损伤胸腰椎骨折的临床疗效。方法对收治的43例不伴神经损伤的单节段胸腰椎骨折病例进行回顾性分析。根据手术方式不同分为2组：20例采用微创通道下椎弓根螺钉固定（微创组）,23例采用传统切开椎弓根螺钉内固定（传统组）;2组均为伤椎短节段固定。分析2组患者的手术时间、术中出血量、术后引流量、戴支具离床时间及术后48h肌酸激酶值;比较2组患者术后疼痛视觉模拟评分（VAS）及欧式功能障碍指数（ODI）;测量并计算术前后伤椎矢状位指数及侧位片Cobb角。结果所有患者均获得随访,平均13.1月（8-20月）。微创组的手术时间、术中出血量、术后引流量、戴支具下床时间、术后48h肌酸激酶数值均少于传统组（P〈0.05）,术后1-3dVAS评分低于传统组（P〈0.05）,术后3月ODI指数优于传统组（P〈0.05）。2组术前后伤椎矢状位指数和侧位片Cobb角比较差别无统计学意义（P〉0.05）。结论短节段微创通道下Wiltse间隙入路椎弓根螺钉内固定治疗胸腰椎骨折出血少、损伤小、早期下床,具有良好的临床疗效。Objective To investigate the effect of short-segment fixation by wiltse gap approach through minimally invasive canal and conventional pedicle screw fixation in treating thoracolumbar frac- tures without nerve iniury. Methods A retrospective analysis on 43 patients with unstable thoracolum- bar fractures without nerve injury were performed. All cases were with single vertebral fracture. Based on the type of the operative treatments, the patients were divided into following two groups, 20 cases trea- ted by minimally invasive canal pedicle screw fixation（minimally invasive group） and 23 cases treated by conventional pedicle screw fixation（traditional group）. All cases received short-segment pedicle fixation at the fracture vertebra. The operation time,intraoperative bleeding volume, postoperative drainage, am- bulation time wearing a brace, and creatine kinase value after 48 hours in both groups were observed. Postoperative visual analogue scale and oswestry disability index between were compared. The recovery of sagittal index of injured vertebral andimprovement of Cobb＇s angle were measured and accounted. Results All patients were followed up for 8 to 20 months（averaged 13.1 months）. The operation time, intraoperative bleeding volume and postoperative drainage,postoperative ambulation time wearing a brace, and creatine kinase values postoperative 48 hours in minimally invasive group were less than those in the traditional group（P〈0.05） ,and the VAS score postoperative 1 to 3 days in minimally invasive group was less than that in the traditional group（P〈0. 05） ,while the ODI index in the minimally invasive group at 3 months after operation was better than that in the traditional group （P〈0.05）. There were no signifi- cant differences in the sagittal index of injured vertebral and Cobb＇s angle improvement between the two groups. Conclusion Short-segment fixation for thoracolumbar fractures using pedicle screws by wiltse gap approach through minimally invasive canal has shorter ope

关 键 词：骨折固定术 内 腰椎 脊柱骨折 胸椎 Wiltse间隙 手术后期间 

分 类 号：R687.3[医药卫生—骨科学]